| Objective:This study focused on the relationship between the level of insulin resistance (IR) or metabolic syndrome(MS) and diabetic retinopathy(DR) in patients with type 2 diabetes mellitus(DM). To investigate whether the level of IR or MS and the severity of DR in patients with type 2 DM is correlated. To analyze whether IR or MS has influences on different types of diabetic macular edema. This study would provide evidence for the early treatment and intervention in patients with type 2 diabetic retinopathy.Methods:The study were retrospective and patients with type 2 DM who had been hospitalized from September 2014 to February 2016 in the department of Endocrinology or Ophthalmology of the Southeast University Zhongda Hospital in Nanjing, Jiangsu Province were examined the fundus condition (including direct and indirect ocular fundus examination, optical coherence tomography and fluorescein fundus angiography if necessary) after other complications were excluded. The patients with DR or DME would be enrolled and peripheral venous blood were drawn after 8 to 12 hours fasting to detect serum biochemical indicators including fasting plasma glucose(FPG), fasting plasma insulin(FINS) or fasting C-peptide(FCP), glycosylated hemoglobin(HbAlc), triglyceride(TG), total cholesterol(TC), high density lipoprotein(HDL), low density lipoprotein(LDL), Apo lipoprotein A(APO-A), Apo lipoprotein B(APO-B). The data were recorded and established database using EXCEL software. According to the formula:BMI(kg/m2)=weight(kg)/height(m)A2 to calculate body mass index(BMI) and using FPG and FINS(or FCP) to evaluate the level of IR. The patients were divided into different groups according to gender, age, course of DM, if PDR existed or not, if DME existed or not, and the type of DME. Each group was consulted and classified.Results:The IR index of nonproliferative diabetic retinopathy(NPDR) distributed in 1.80～14.45 and the average was (2.99±1.20). The IR index of proliferative diabetic retinopathy(PDR) distributed in 2.22-15.34 and the average was (4.14±2.47). It was estimated that the IR index was positively correlated with the degree of DR. The IR index of PDR in binary logistic regression analysis had statistical sense(P<0.05) indicating that IR was one of the risk factors of PDR. The higher the IR index was, the higher risk of PDR would be. The IR index of DME distributed in 2.35～21.08 and the average was (5.95±3.49).The IR index of non-DME distributed in 1.80～15.34 and the average was (3.51±1.97). It was estimated that the IR index was positively correlated with the degree of DME. The IR index of DME in binary logistic regression analysis had statistical sense(P<0.05) indicating that IR was one of the risk factors of DME. The higher the IR index was, the higher risk of DME would be.The TC, TG, APO-A, HDL, HbAlc, BMI were higher in patients with PDR compared with patients with NPDR. But the correlation test had statistical sense(P<0.05) were only in the analysis of TC, TG, BMI which means TC, TG, BMI were the risk factors of PDR. The higher the TC, TG, BMI were, the higher risk of PDR would be. APO-A, APO-B, HDL, LDL, HbAlc might also affect the occurrence of PDR, but it was not statistic significant difference in this study.The TC, LDL, BMI were higher in patients with DME indicating that the rise of TC, LDL, BMI might result in the occurrence of DME. The BMI of DME patients in correlation test had statistical sense(P<0.05) indicating that BMI was one of the risk factors of DME, while P(TG) and P(LDL) were greater than 0.05 which indicating that there were no direct relationship between these data and DME. The TC, APO-A, APO-B, HDL, HbAlc were higher in patients without DME indicating the possibility of the influence on DME. The analysis of HDL proved HDL in serum was a protect factor of DME.According to the analysis of the data of PDR, there was not direct relationship with gender or age(P>0.05), while the course of DM had positive correlation with PDR(P<0.05). The average DM course of patients with NPDR was (12.01±7.15) years and the average DM course of patients with PDR was (12.21±6.42)years. The longer the course of DM was, the higher risk of PDR would be(OR>1).According to the analysis of the data of DME, there was no direct relationship with gender, age or course of DM, and whether the patients had DME or not. And there was also no direct relationship between gender, age or course of DM and the different types of DME.Conclusion:(1)Insulin resistance was one of the important factors effected on diabetic retinopathy. IR had positive correlation with the occurrence and development of DR, and the occurrence of DME. The higher the IR index was, the higher risk of DR and DME would be.(2)There was a close relationship between DR and the disorder of lipid metabolism causing by metabolic syndrome. The increasing level of TC, TG, BMI contributed to the risk of PDR. BMI was a risk factor of the occurrence of DME and HDL was a protect factor of the occurrence of DME.(3)Gender or age had no direct link to the occurrence and development of DR. The length of course of DM had influence on the development of DR, while the risk of PDR would rise with the increase of the course of DM. Neither the patients had DME or not nor the different types of DME was direct relationship between gender, age or the course of DM. |
